| NPI | 1487886735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-01563) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: SC 1396) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2018-10-30 |