| NPI | 1215402185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 2279P3900X Respiratory Therapist, Registered, Neonatal/Pediatrics (Licence: CA 26505) |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2024-02-20 |