| NPI | 1992154934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 53913) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA PA53913) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2025-08-12 |