| NPI | 1801322466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA54383) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: CA P29948) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2022-06-08 |