| NPI | 1023775277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C0008557) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: DC PA200001489) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-11-23 |
| Last Update Date | 2024-05-09 |