| NPI | 1407140098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 243U00000X Radiology Practitioner Assistant (Licence: OR 912827) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2017-05-12 |