NPI | 1164805768 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 3370) |
Additional Taxonomies | 2471C3402X Radiologic Technologist, Radiography (Licence: CT 6036) |
Enumeration Date | 2015-07-01 |
Last Update Date | 2023-06-30 |