| NPI | 1306944723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 17225) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: CA 0PA172250) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-02-22 |