| NPI | 1295949865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PR 079-PA) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: PR 1562B) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-12-03 |