| NPI | 1073550737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: DE C7-0005333) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD-237) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2013-06-25 |