| NPI | 1285676353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 58266) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CT 893) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 000893) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2024-02-16 |