| NPI | 1780575092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-15504) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NC 0010-15504) |
| Enumeration Date | 2025-07-14 |
| Last Update Date | 2025-12-30 |