| NPI | 1558795005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME140032) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2013-09-01 |
| Last Update Date | 2020-04-20 |