| NPI | 1770213878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 8990) |
| Additional Taxonomies | 2278G1100X Respiratory Therapist, Certified General Care |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2022-06-13 |