| NPI | 1710590542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 4200) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 4200) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2023-04-20 |