| NPI | 1336897040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 60894) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA PA60894) |
| 208M00000X Hospitalist (Licence: CA PA60894) | |
| Enumeration Date | 2022-03-11 |
| Last Update Date | 2022-03-11 |