| NPI | 1215586656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601009517) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5601009517) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2023-09-19 |