| NPI | 1043444151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-07847) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NC 0010-07847) |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2020-09-13 |