| NPI | 1215256847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL PA9105451) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105451) |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2020-11-13 |