| NPI | 1386245579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113805) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 17663) |
| 363AM0700X Physician Assistant, Medical (Licence: MI 5601011920) | |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2023-10-30 |