| NPI | 1811964232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA14579) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: CA P00762) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2015-07-27 |