| NPI | 1316721335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA PA63970) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA63970) | |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2024-06-24 |