| NPI | 1093476863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: MO PENDING) |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2022-01-06 |