| NPI | 1396872263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME 121176) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME 121176) |
| 261QR0207X Clinic/Center, Radiology, Mobile Mammography (Licence: FL ME121176) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2022-05-24 |