| NPI | 1073982245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ID PA1456) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2025-11-25 |