| NPI | 1730146135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 55012) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 001255) |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 001255) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NH LT-3705) | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2016-07-06 |