| NPI | 1114536943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL TPPA687) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: AZ 198878) |
| 2471S1302X Radiologic Technologist, Sonography (Licence: AZ 198878) | |
| 363A00000X Physician Assistant (Licence: PR 002074-PA) | |
| 170100000X Medical Genetics, Ph.D. Medical Genetics (Licence: 105453) | |
| 202K00000X (Licence: AZ 198878) | |
| 246RP1900X Technician, Pathology, Phlebotomy (Licence: AZ 202010152365) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: AZ 198878) | |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2024-05-08 |