| NPI | 1578121869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA67885) |
| Additional Taxonomies | 227900000X Respiratory Therapist, Registered |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2026-05-26 |