| NPI | 1295872240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME136620) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101283789) |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9102932) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2025-03-31 |