| NPI | 1497792162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME122262) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: PR 8643) |
| 207U00000X Nuclear Medicine (Licence: PR 8643) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: PR 8643) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2019-11-12 |