| NPI | 1386463529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PR 009PA) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: PR 1149) |
| Enumeration Date | 2024-10-04 |
| Last Update Date | 2024-10-11 |