| NPI | 1962238394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9119284) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: FL PA9119284) |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: FL PA9119284) | |
| Enumeration Date | 2024-09-11 |
| Last Update Date | 2025-06-09 |