| NPI | 1851871172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1823) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ID 1851871172) |
| 2471C3401X Radiologic Technologist, Computed Tomography (Licence: MN 408447) | |
| 2471C3402X Radiologic Technologist, Radiography (Licence: MN 408447) | |
| 363A00000X Physician Assistant (Licence: WA PA61007077) | |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2020-06-03 |