| NPI | 1659095594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OK PA4953) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 4953) |
| 363AM0700X Physician Assistant, Medical (Licence: OK 4953) | |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2022-12-06 |