| NPI | 1013919505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110001164) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0110001164) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2021-02-05 |