| NPI | 1750785432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C05524) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MD C05524) |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2018-09-21 |