NPI | 1104491083 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 2148) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.008467) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-05-24 |
Last Update Date | 2025-07-29 |