NPI | 1871055111 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102206223) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2019-04-04 |
Last Update Date | 2023-08-17 |