| NPI | 1194836726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 005072) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL PAT9103786) |
| 363AM0700X Physician Assistant, Medical (Licence: GA 005072) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-06-08 |