| NPI | 1457437022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9100705) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0008876) |
| 207P00000X Emergency Medicine (Licence: FL PA9100705) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2025-01-08 |