| NPI | 1922071414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MT MED-PAC-LIC-491) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA 329) |
| 363A00000X Physician Assistant (Licence: MT 491) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2021-12-14 |