| NPI | 1124681796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL PA9112231) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9112231) |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2023-10-06 |