| NPI | 1003850355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1314) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: SC SC015028) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2013-03-14 |