| NPI | 1700014974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME 120404) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R8642) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL TRN14951) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 40657) | |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2015-07-21 |