| NPI | 1740234772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 1944) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 1944023) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WI 1944023) | |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: WI 1944023) | |
| 207PT0002X Emergency Medicine, Medical Toxicology (Licence: WI 1944023) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2019-10-11 |