NPI | 1952839300 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: UT 13340715-1204) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT017615) |
207U00000X Nuclear Medicine (Licence: NY 310879-01) | |
Enumeration Date | 2017-05-30 |
Last Update Date | 2023-10-22 |