| NPI | 1760482251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 001757) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 1253023) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2007-07-27 |