| NPI | 1841891520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110007973) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-14811) |
| 207P00000X Emergency Medicine (Licence: VA 0110-007973) | |
| Enumeration Date | 2020-11-08 |
| Last Update Date | 2025-07-18 |