| NPI | 1710533286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09318) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 0010-09318) |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2022-08-01 |