| NPI | 1285655605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MS PA065) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS PA00065) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2009-10-08 |