| NPI | 1629543517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 11443295-1206) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2024-07-25 |