| NPI | 1568625275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: HI MD-15395) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q9554) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD-15395) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A132302) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX Q9554) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2020-09-15 |