| NPI | 1649006321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: LA 343921) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 343921) |
| 208M00000X Hospitalist (Licence: LA 343921) | |
| Enumeration Date | 2024-09-10 |
| Last Update Date | 2025-11-19 |