| NPI | 1780339473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 4300) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: SC 4300) |
| Enumeration Date | 2022-02-21 |
| Last Update Date | 2022-02-22 |