| NPI | 1760434757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N7191) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 002348) |
| 363A00000X Physician Assistant (Licence: GA 004610) | |
| 363A00000X Physician Assistant (Licence: TX PA 01359) | |
| 363A00000X Physician Assistant (Licence: NY 004050-1) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2010-09-29 |