| NPI | 1457442691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NM 95-PA19) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA 10003262) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2012-04-03 |