| NPI | 1073247615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-07-11 |
| Last Update Date | 2022-09-13 |