| NPI | 1598866691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: UT 5703274-1206) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-12-01 |