| NPI | 1831800846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0009078) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MD C0009078) |
| Enumeration Date | 2022-12-09 |
| Last Update Date | 2025-11-26 |