| NPI | 1003522921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL pa9116785) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 9116785) |
| 207R00000X Internal Medicine (Licence: FL pa9116785) | |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2023-01-31 |