| NPI | 1801645296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MN 1170-2204-1472) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2024-05-16 |
| Last Update Date | 2024-05-16 |