| NPI | 1417763137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9119532) |
| Additional Taxonomies | 207RX0202X Internal Medicine, Medical Oncology (Licence: FL PA9119532) |
| Enumeration Date | 2024-12-06 |
| Last Update Date | 2025-02-26 |