| NPI | 1225550312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5601008455) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MA059589) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2021-03-12 |