| NPI | 1154424463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 2932) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: GA 2932) |
| 363A00000X Physician Assistant (Licence: GA 002932) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2023-06-22 |