| NPI | 1962805226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60938311) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 5857) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WA PA60938311) | |
| 363A00000X Physician Assistant (Licence: AZ 5857) | |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2019-08-22 |