| NPI | 1649625526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA53868) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 53868) |
| 363A00000X Physician Assistant (Licence: IA 126144) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2024-07-29 |