| NPI | 1982066585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 1749) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 1749) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2023-07-06 |