| NPI | 1790243293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: FL 525082) |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2021-09-29 |