| NPI | 1063497931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AR P-T0726) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2004003095) |
| 363AM0700X Physician Assistant, Medical (Licence: MO 2004003095) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2018-03-17 |