NPI | 1467844613 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05605) |
Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 0010-05605) |
Enumeration Date | 2015-02-25 |
Last Update Date | 2020-10-01 |