| NPI | 1164909479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 10931513-1206) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: UT 1153249) |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2019-07-13 |