| NPI | 1073827820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 0003542) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA06868) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2023-06-16 |