| NPI | 1114672664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-11978) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: NC 0010-11978) |
| Enumeration Date | 2022-02-14 |
| Last Update Date | 2024-09-16 |