| NPI | 1033197454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 50461) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: OH 068200) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2024-08-20 |