| NPI | 1932438173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY 08TX1345) |
| Additional Taxonomies | 243U00000X Radiology Practitioner Assistant (Licence: WY 08 TX 1345) |
| Enumeration Date | 2009-12-17 |
| Last Update Date | 2009-12-18 |