| NPI | 1255960134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-11505) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NC 0010-11505) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2024-07-15 |