| NPI | 1255828166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME171043) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 11427675-1205) |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2024-11-08 |