| NPI | 1326699539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9886) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: GA 530131) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-09-28 |
| Last Update Date | 2020-09-16 |