| NPI | 1952145948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2024023293) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2024023293) |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2024-08-07 |