| NPI | 1831050491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 8663-23) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WI 8663-23) |
| Enumeration Date | 2025-11-21 |
| Last Update Date | 2025-11-25 |