| NPI | 1538902481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA227644) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR PA227644) |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2026-06-30 |