| NPI | 1992314587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4231) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0110-007376) |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2021-07-19 |