| NPI | 1972887768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MO P-16941) |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2022-08-12 |