| NPI | 1053935825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008574) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: DE 1172000) |
| 363A00000X Physician Assistant (Licence: 1172000) | |
| 207L00000X Anesthesiology (Licence: VA 0110008574) | |
| Enumeration Date | 2020-06-07 |
| Last Update Date | 2026-05-01 |