| NPI | 1720154594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 004894) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: GA 004894) |
| Enumeration Date | 2006-11-25 |
| Last Update Date | 2011-03-25 |