| NPI | 1689358012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207RR0500X Internal Medicine, Rheumatology (Licence: GA 11792) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2023-08-06 |