NPI | 1861469900 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 62256) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101102522) |
2083X0100X Preventive Medicine, Occupational Medicine (Licence: VA 0101102522) | |
Enumeration Date | 2006-03-08 |
Last Update Date | 2023-08-08 |