| NPI | 1659457281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3527) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 3527) |
| 363AM0700X Physician Assistant, Medical (Licence: AZ 3527) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2021-12-08 |