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 |