| NPI | 1235869272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-11733) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NC 0010-11733) |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2024-01-22 |