| NPI | 1669497319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 002148) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MI 5601002148) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2023-11-28 |