| NPI | 1720055643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 003555) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 003555) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2015-04-10 |