| NPI | 1952997876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV WV-SE-1771) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: PA 204844) |
| 208M00000X Hospitalist (Licence: WV WV-SE-1771) | |
| Enumeration Date | 2020-12-15 |
| Last Update Date | 2021-06-11 |