| NPI | 1598308777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061224) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MA061224) |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2019-12-02 |