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