| NPI | 1427055961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 110249) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 110249) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2025-03-20 |