| NPI | 1467529644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-00594) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 001000594) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2022-01-17 |