| NPI | 1134189517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 101659) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 101659) |
| 363A00000X Physician Assistant (Licence: NC 101659) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2020-10-29 |