| NPI | 1477079606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL UO9876) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 54761) |
| 363A00000X Physician Assistant (Licence: FL PA9111733) | |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2024-07-08 |