| NPI | 1821529918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1596) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VA 0110005599) | |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2026-05-07 |