| NPI | 1174836696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC LL84499) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: SC TL1534) |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2020-06-15 |