| NPI | 1518902824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-04978) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD C0002685) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2025-08-18 |