| NPI | 1275684300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301111862) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 010696) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2024-03-06 |