| NPI | 1720305592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005718) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: MI 3202006021) |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2014-12-18 |