| NPI | 1912977125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2019-01943) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: VA 0102201360) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2020-03-27 |