| NPI | 1154653137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA002906L) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MA002906L) |
| Enumeration Date | 2010-02-02 |
| Last Update Date | 2022-06-27 |