| NPI | 1891254561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL PA9111940) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9111940) |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2026-04-10 |