NPI | 1952445249 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: LA PA.A10303.RX) |
Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: LA PO835285) |
Enumeration Date | 2007-02-19 |
Last Update Date | 2022-07-21 |