| 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 |