| NPI | 1275608838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA01271) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 3118) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2021-12-06 |