| NPI | 1063255586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110010146) |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: VA 0110010146) |
| Enumeration Date | 2024-06-13 |
| Last Update Date | 2024-08-14 |