NPI | 1063843225 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS020060) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA MA056530) |
390200000X Student in an Organized Health Care Education/Training Program | |
390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT017806) | |
Enumeration Date | 2013-12-12 |
Last Update Date | 2024-08-12 |