| NPI | 1417909987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601004193) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MI 5601004193) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2007-10-30 |