| NPI | 1356465611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2020-00890) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2024-02-12 |