| NPI | 1063843225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS020060) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA MA056530) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT017806) | |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2024-08-12 |