| NPI | 1497310148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09392) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: NC STUDENT) |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2024-07-11 |