| NPI | 1417107822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 4295) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 4295) |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2023-03-01 |