| NPI | 1306469630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME160641) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME160641) |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2023-03-03 |