| NPI | 1497538466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 6310) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: M5036650) |
| Enumeration Date | 2023-08-15 |
| Last Update Date | 2023-10-13 |