| NPI | 1598571168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-15216) |
| Additional Taxonomies | 2279G1100X Respiratory Therapist, Registered, General Care |
| Enumeration Date | 2024-12-09 |
| Last Update Date | 2025-11-13 |