| NPI | 1689450496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: TX 774647) | |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: NC P539664) | |
| 363A00000X Physician Assistant (Licence: TX PA18606) | |
| Enumeration Date | 2023-09-06 |
| Last Update Date | 2025-09-22 |