| NPI | 1215098504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD046109) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 243064) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A119028) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2018-07-24 |