| NPI | 1649278334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NE 1967) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL PA9101249) |
| 363A00000X Physician Assistant (Licence: GA 002541) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2017-05-12 |