| NPI | 1487034583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME145082) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL38205) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC LL38205) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2024-03-04 |