| NPI | 1831668508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: CA 59749) |
| Enumeration Date | 2018-11-24 |
| Last Update Date | 2021-10-20 |