| NPI | 1467926295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA56677) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 56677) |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2021-04-16 |