| NPI | 1922721786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0012306) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: MD 0214481) |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2025-07-23 |