NPI | 1164496030 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 3179) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 3179) |
363AS0400X Physician Assistant, Surgical (Licence: AZ 3179) | |
Enumeration Date | 2006-02-15 |
Last Update Date | 2019-01-22 |