| NPI | 1750326989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD C0002285) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2019-03-22 |