| NPI | 1184618464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME86485) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 35453) |
| 208D00000X General Practice (Licence: FL ME86485) | |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2020-03-05 |