| NPI | 1952839300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: NY 310879-01) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT017615) |
| 207U00000X Nuclear Medicine (Licence: UT 13340715-1204) | |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2024-06-21 |