| NPI | 1720154594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 4894) |
| Additional Taxonomies | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: GA 004894) |
| Enumeration Date | 2006-11-25 |
| Last Update Date | 2024-10-03 |