| NPI | 1730371998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 4384) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 1972023) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2014-08-27 |