| NPI | 1942861182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 56950) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 56950) |
| 207Q00000X Family Medicine (Licence: CA 56950) | |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2023-09-26 |