| NPI | 1528065844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2006034878) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 085-002185) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2015-03-03 |