| NPI | 1356861694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NC 0010-07359) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NC 0010-07359) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2018-09-27 |