| NPI | 1629333810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME144626) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A131651) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2025-09-09 |