| NPI | 1174740229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003662) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: NM 5601003662) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2023-10-25 |