| NPI | 1407618705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9118389) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL PA9118389) |
| Enumeration Date | 2024-01-23 |
| Last Update Date | 2024-02-12 |