| NPI | 1699407486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12819595-1206) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: UT 12819595-1206) |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2023-01-30 |