| NPI | 1326425646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 326828) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2024-05-04 |