| NPI | 1073598355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 2438) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 2438) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2023-11-14 |