| NPI | 1306250329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110004600) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VA 0100-004600) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2024-07-05 |