| NPI | 1467218792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 5883) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: TN PA0000005883) |
| Enumeration Date | 2024-02-23 |
| Last Update Date | 2024-05-01 |