| NPI | 1245639624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME153171) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PAT9108098) |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2022-12-14 |