| NPI | 1952353344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL PA2295) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA2295) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2016-02-15 |