| NPI | 1700369121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006407) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: VA 1156952) |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2024-03-28 |