| NPI | 1790456036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 11471) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: GA 11471) |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2023-08-14 |