| NPI | 1437168598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME 86772) |
| Additional Taxonomies | 261QR0200X Clinic/Center, Radiology (Licence: FL ME86772) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2015-05-13 |