| NPI | 1346771037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA1232) |
| Additional Taxonomies | 2471N0900X Radiologic Technologist, Nuclear Medicine Technology (Licence: AL 038752) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2022-05-26 |