| NPI | 1366937278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9111331) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: FL 0111331) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2022-01-18 |