| NPI | 1407393622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX T7582) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX T7582) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T7582) | |
| Enumeration Date | 2017-01-25 |
| Last Update Date | 2024-08-01 |