| NPI | 1134795388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9114731) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: FL PMD530866) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-28 |
| Last Update Date | 2025-01-27 |