| NPI | 1457465122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0110001845) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2024-04-25 |