| NPI | 1073599619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 2816) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 2816) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2020-12-22 |