| NPI | 1669845467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA057992) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: PA 100032) |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2021-05-20 |