| NPI | 1649240011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: MI 5101014320) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: MI 5101014320) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101014320) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2026-06-08 |