| NPI | 1730671991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME171303) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 26299) |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2025-03-13 |