| NPI | 1295719318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 103499) |
| Additional Taxonomies | 207RH0000X Internal Medicine, Hematology (Licence: NC 103499) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2020-09-29 |