| NPI | 1871511881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY PA 011076-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL PA9104930) |
| 207P00000X Emergency Medicine (Licence: NM 134) | |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9104930) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2021-09-17 |