| NPI | 1659747483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OT019441) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA057622) |
| 363AM0700X Physician Assistant, Medical (Licence: OH 50.006022) | |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2019-06-20 |