| NPI | 1649266719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA 9103872) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 004086) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2009-12-23 |