| NPI | 1356999312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WV 2286) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WV 2286) |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2025-04-04 |