| NPI | 1932817194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 2471C3401X Radiologic Technologist, Computed Tomography (Licence: CA 535689) |
| 2471C3402X Radiologic Technologist, Radiography (Licence: CA 535689) | |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2022-11-07 |