| NPI | 1073210084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10003932A) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: PA 226005) |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: M5059651) | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2023-03-07 |