| NPI | 1952876310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA060248) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0012426) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: PA MA060248) | |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2026-06-11 |