| NPI | 1417996620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 21907) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102205445) |
| 363AM0700X Physician Assistant, Medical (Licence: MD C0003173) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2023-12-04 |