| NPI | 1184239949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL 9113509) |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2022-10-06 |