| NPI | 1821481615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL PA9108615) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9108615) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2021-03-12 |