| NPI | 1275517443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 1690-023) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 1690023) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2018-07-31 |