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 | 2007-07-08 |