| NPI | 1619529351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09254) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: NC 0010-09254) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2023-11-27 |