| 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 |