| NPI | 1689314486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: CA p23527) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2022-12-12 |