| NPI | 1053144238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 12628) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 12628) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-08-22 |
| Last Update Date | 2024-11-07 |