| NPI | 1538952072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 3068) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WV 1227100) |
| Enumeration Date | 2025-05-27 |
| Last Update Date | 2025-08-18 |