| NPI | 1235604828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN 3743) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TN 3743) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2022-03-31 |