| NPI | 1326013319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: HI MD-12981) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME104869) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2024-09-05 |