| NPI | 1003484437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD1233) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9114688) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-13 |
| Last Update Date | 2023-05-10 |