| NPI | 1699241588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008881) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5601008881) |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2018-11-02 |