| NPI | 1619504529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN 4504) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: GA 9700) |
| 363AM0700X Physician Assistant, Medical (Licence: GA 9700) | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2021-08-10 |