| NPI | 1164404067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: DC PA30204) |
| 363A00000X Physician Assistant (Licence: DC pa30204) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2021-04-12 |