| NPI | 1811561756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110007421) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0110007421) |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110007421) | |
| Enumeration Date | 2021-05-15 |
| Last Update Date | 2023-03-06 |