| NPI | 1427438803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME129643) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2023-05-01 |