| NPI | 1053545657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003680) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5601003680) |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2009-06-29 |