| NPI | 1447715263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C07100) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0011740) |
| 207P00000X Emergency Medicine (Licence: MD C0007100) | |
| Enumeration Date | 2019-02-06 |
| Last Update Date | 2023-06-15 |