| NPI | 1073276853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: VA E071805908) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2022-09-01 |