| NPI | 1245653534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-04725) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 0010-04725) |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2022-09-29 |