| NPI | 1336255504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003270) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 003270) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2021-05-08 |