| NPI | 1821037896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 102162) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 644) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2015-06-04 |