| NPI | 1104847003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 70059) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MA 234159) |
| 286500000X Military Hospital (Licence: IA 36355) | |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2023-06-15 |