| NPI | 1962457010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110840582) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: VA 0110840582) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2024-10-09 |