| NPI | 1891932539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 20088) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: CA 29900) |
| Enumeration Date | 2009-01-16 |
| Last Update Date | 2021-01-27 |