| NPI | 1093343402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MD C0008038) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C08038) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2021-11-10 |