| NPI | 1063099349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5804) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: WI 7021767) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2025-03-13 |