| NPI | 1811186752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA200001310) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0110002588) |
| 363A00000X Physician Assistant (Licence: MD C00003565) | |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2022-05-12 |