| NPI | 1174551873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AL PA465) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA465) |
| 207P00000X Emergency Medicine (Licence: AL PA465) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2010-10-01 |