| NPI | 1063432714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL PA2770) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA2770) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |