| NPI | 1841399953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 4036) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 0040369) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2023-09-25 |