NPI | 1255699781 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0132000005) |
Additional Taxonomies | 2471C3402X Radiologic Technologist, Radiography (Licence: VA 0120004083) |
Enumeration Date | 2012-05-03 |
Last Update Date | 2012-05-03 |