| NPI | 1760197958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MS 1020521) |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2023-04-26 |