| NPI | 1902832033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL pa9104665) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 0033391) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2013-07-22 |