| NPI | 1285658955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601004366) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5601004366) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2017-03-02 |