| NPI | 1902491798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10321) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: GA 1181534) |
| 363AM0700X Physician Assistant, Medical (Licence: 1181534) | |
| 363AS0400X Physician Assistant, Surgical (Licence: 1181534) | |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2021-06-11 |