| NPI | 1366891418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5745) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MA E872236) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2023-01-27 |