| NPI | 1194174839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A193043) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2026-06-29 |