| NPI | 1164072203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012809) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 0010-09334) |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2025-05-13 |