| NPI | 1962734921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 1208082) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: GA 1325432) |
| Enumeration Date | 2010-02-02 |
| Last Update Date | 2023-03-31 |