| NPI | 1194485243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: AZ 11851) |
| Enumeration Date | 2021-12-29 |
| Last Update Date | 2026-07-26 |