| NPI | 1215247010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2010-10-14 |