| NPI | 1467135434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CA E168890) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-08-08 |
| Last Update Date | 2025-08-08 |