NPI | 1619939667 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 104135) |
Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 104135) |
Enumeration Date | 2006-04-05 |
Last Update Date | 2020-09-13 |