| NPI | 1124306295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: ID PA-1045) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| 207P00000X Emergency Medicine (Licence: WA 60236691) | |
| Enumeration Date | 2011-07-23 |
| Last Update Date | 2013-04-23 |