| NPI | 1487897393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 028665) |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: CT 001236) | |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2022-09-22 |