| NPI | 1992880884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 102833) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 102833) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2012-03-06 |