| NPI | 1104323385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME142081) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME142081) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2023-00440) | |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2024-08-01 |