| NPI | 1255863973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR DO193580) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR DO193580) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2023-07-14 |