| NPI | 1689450496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: NC P539664) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2023-09-06 |
| Last Update Date | 2024-10-02 |