| NPI | 1083383186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9114) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: PR 000829-P.A.) |
| Enumeration Date | 2021-09-10 |
| Last Update Date | 2023-06-08 |