| NPI | 1659484640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2471V0106X Radiologic Technologist, Vascular-Interventional Technology (Licence: VT 051-0001315) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VT 055-0030731) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2025-09-11 |