| NPI | 1003296146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME162796) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101261119) |
| 207Q00000X Family Medicine (Licence: VA 0116028149) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2025-07-01 |