| NPI | 1932876158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: TN 4713) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 4713) |
| 363A00000X Physician Assistant (Licence: MO 2022049473) | |
| 363AM0700X Physician Assistant, Medical (Licence: TN 4713) | |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2024-09-05 |