| NPI | 1487640405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME73293) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME-0073293) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2015-05-01 |