| NPI | 1720807837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14676) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: NC P036838) |
| Enumeration Date | 2024-10-07 |
| Last Update Date | 2024-11-12 |