| NPI | 1700303146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110398) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: FL 9110398) |
| 207Q00000X Family Medicine (Licence: FL PA9110398) | |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2022-07-21 |