| NPI | 1053835793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 10778) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: OR PA184727) |
| 363AM0700X Physician Assistant, Medical (Licence: OR PA184727) | |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2022-01-03 |