| NPI | 1003990573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV PA2994) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: ID RPA229) |
| 363AM0700X Physician Assistant Medical (Licence: UT 342951-1206) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2024-03-05 |