NPI | 1073020400 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 1198850) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
146L00000X Emergency Medical Technician, Paramedic (Licence: GA M5024678) | |
Enumeration Date | 2018-01-08 |
Last Update Date | 2022-08-03 |