| NPI | 1225069776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME70084) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME70084) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME70084) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2026-04-26 |