| NPI | 1114932605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NC 102455) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 102455) |
| 363AM0700X Physician Assistant Medical (Licence: NC 102455) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2020-03-18 |