| NPI | 1881046225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA NA) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 003671) |
| 363A00000X Physician Assistant (Licence: VA 0110006479) | |
| 363A00000X Physician Assistant (Licence: NC 0010-07744) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 003671) | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2024-02-13 |