| NPI | 1669907192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA 193406) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA 193406) | |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2024-06-01 |