| NPI | 1588710230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0000767) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD C0000767) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2018-07-26 |