| NPI | 1578698221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8490) |
| Additional Taxonomies | 227900000X Respiratory Therapist, Registered (Licence: NY 003934) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2021-09-24 |