| NPI | 1063101129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 12740) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 12740) |
| Enumeration Date | 2023-05-04 |
| Last Update Date | 2024-11-20 |