NPI | 1053860361 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 11096) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-09-27 |
Last Update Date | 2022-07-26 |