| NPI | 1386127538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 100767) |
| Additional Taxonomies | 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: NC 100767) |
| Enumeration Date | 2018-09-13 |
| Last Update Date | 2019-02-22 |