| NPI | 1154713808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 29490) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 29490) |
| 286500000X Military Hospital | |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2021-06-21 |