| NPI | 1326587494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 31050) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2024-10-23 |