| NPI | 1326767559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9116437) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL PA9116437) |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2022-10-04 |