| NPI | 1023999414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 17631-I) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 2564-PA) |
| Enumeration Date | 2025-09-11 |
| Last Update Date | 2025-09-12 |