| NPI | 1659130490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA64114) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA64114) |
| 146N00000X Emergency Medical Technician, Basic (Licence: CA E018059) | |
| Enumeration Date | 2024-03-14 |
| Last Update Date | 2025-11-30 |