| NPI | 1285825208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-01834) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: NC P071746) |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: GA 6611) | |
| 363A00000X Physician Assistant (Licence: NC 0010-01834) | |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA06145) | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2019-11-13 |