| NPI | 1871570572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: 1041602) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: DE C5-0000519) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2008-12-31 |