| NPI | 1255452736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2043) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NC 0010-00361) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2023-06-16 |