| NPI | 1629056916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L3822) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX L3822) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME98490) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2023-07-19 |