| NPI | 1346595782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601006488) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MI 3203040182) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2023-06-08 |