NPI | 1932804713 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 9541-PA-C) |
Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: AZ 9541-PA-C) |
207R00000X Internal Medicine (Licence: AZ 9541-PA-C) | |
Enumeration Date | 2023-04-03 |
Last Update Date | 2023-04-03 |