| NPI | 1861065351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: 1191394) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: E3331533) |
| 376K00000X Nurse's Aide (Licence: PA 10079953) | |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2021-07-21 |