| NPI | 1861851784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06199) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 001006199) |
| Enumeration Date | 2016-02-19 |
| Last Update Date | 2020-06-10 |