| NPI | 1649216870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C001190) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD C001190) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2013-08-20 |