| NPI | 1922750900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: NC 0010-11906) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-11906) |
| Enumeration Date | 2022-01-21 |
| Last Update Date | 2022-03-21 |