| NPI | 1083977805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9109238) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL PA9109238) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2025-09-19 |