| NPI | 1669677415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 1648) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 000410) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2024-07-01 |