| NPI | 1427255769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 2471C3401X Radiologic Technologist, Computed Tomography (Licence: FL jx39313) |
| 2471C3402X Radiologic Technologist, Radiography (Licence: FL jx39313) | |
| 2471V0106X Radiologic Technologist, Vascular-Interventional Technology (Licence: FL jx39313) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2025-09-11 |