| NPI | 1790275287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA55876) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: CA P-23257) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2018-11-06 |