| NPI | 1295780898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003038) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI MA0951764) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2021-03-29 |