| NPI | 1093038952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9107354) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: FL CRT38045) |
| 363A00000X Physician Assistant (Licence: TN 1826) | |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2022-07-21 |