| NPI | 1689651010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 02004880B) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 1610-023) |
| 363A00000X Physician Assistant (Licence: IL 085-002276) | |
| 207P00000X Emergency Medicine (Licence: IL 085-002276) | |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2016-07-15 |