| NPI | 1619166196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 16571) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 297697) |
| 363A00000X Physician Assistant (Licence: WI 2210) | |
| 363A00000X Physician Assistant (Licence: MN 10562) | |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2023-12-26 |