| NPI | 1275215642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: CA P36978) |
| Enumeration Date | 2023-08-03 |
| Last Update Date | 2025-08-05 |