| NPI | 1568698942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 64316) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5601005541) |
| 363A00000X Physician Assistant | |
| 363A00000X Physician Assistant (Licence: MI 5601005541) | |
| 363A00000X Physician Assistant (Licence: WI 2450-023) | |
| Enumeration Date | 2009-05-30 |
| Last Update Date | 2018-07-26 |