| NPI | 1720072077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110001119) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0110001119) |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2014-02-07 |