| NPI | 1245579424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102207112) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 4662) |
| 363A00000X Physician Assistant | |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-04101) | |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2022-05-10 |