| NPI | 1285210229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 587423) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: WI 70110491) |
| Enumeration Date | 2021-03-21 |
| Last Update Date | 2022-08-25 |