| NPI | 1134210768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 2144) |
| Additional Taxonomies | 207RH0002X Internal Medicine Hospice and Palliative Medicine (Licence: AZ 2144) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2018-08-24 |