| NPI | 1669982286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C06583) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MD C06583) |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2019-06-07 |