| NPI | 1508339250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08714) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 0010-08714) |
| 208M00000X Hospitalist (Licence: NC 0010-08714) | |
| Enumeration Date | 2019-01-05 |
| Last Update Date | 2026-07-06 |