NPI | 1174961916 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME 128153) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN20603) |
363AM0700X Physician Assistant, Medical (Licence: FL TRN20603) | |
Enumeration Date | 2013-06-13 |
Last Update Date | 2016-05-04 |