| NPI | 1992078695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME136873) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 27599) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2021-00679) | |
| 208D00000X General Practice (Licence: NE 27599) | |
| Enumeration Date | 2012-02-12 |
| Last Update Date | 2021-04-15 |