NPI | 1336141910 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110001333) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0110001333) |
Enumeration Date | 2005-08-12 |
Last Update Date | 2018-07-31 |