NPI | 1952800336 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX S3067) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2018-02-12 |
Last Update Date | 2024-06-13 |