| NPI | 1639450778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9106961) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: GA 965) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: GA 965) | |
| 363A00000X Physician Assistant (Licence: MI 5601010961) | |
| 363AM0700X Physician Assistant, Medical (Licence: NY 023516) | |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA055058) | |
| 363A00000X Physician Assistant (Licence: MA PA-TF-0188) | |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2023-06-23 |