| NPI | 1841909710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9116774) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 9116774) |
| 363AM0700X Physician Assistant, Medical (Licence: FL 9116774) | |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2024-12-04 |