| NPI | 1861443038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MO 2007034234) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 003759) |
| 207P00000X Emergency Medicine (Licence: IL 085003201) | |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2011-01-07 |