| NPI | 1891767398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 103459) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: NC 103459) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 103459) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2023-10-02 |