| NPI | 1073904181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 7517) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 007517) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2024-06-10 |