| NPI | 1427254473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471V0106X Radiologic Technologist, Vascular-Interventional Technology (Licence: FL 307118) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 03FL1057) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2007-07-08 |