| NPI | 1023520475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA OA004386) |
| Additional Taxonomies | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: PA MA059492) |
| 363AM0700X Physician Assistant, Medical (Licence: DE C5-0011688) | |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2022-02-21 |