| NPI | 1508421751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: OR PA197772) |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2022-01-17 |