NPI | 1811394976 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 59206) |
Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NV 74381) |
Enumeration Date | 2014-12-04 |
Last Update Date | 2021-05-17 |