| NPI | 1457389116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 001720) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 2883) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2021-04-29 |