| NPI | 1497461289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 0010-13379) |
| Enumeration Date | 2023-01-25 |
| Last Update Date | 2025-12-16 |