| NPI | 1649226796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 005450) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 005450-1) |
| 207P00000X Emergency Medicine (Licence: NY 005450) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2018-06-15 |