| NPI | 1689155673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 7194) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2019-01-30 |