| NPI | 1730708660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 86052) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME157042) |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2025-07-02 |