| NPI | 1154953545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA062515) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2511) |
| 363A00000X Physician Assistant (Licence: MD C007902) | |
| 363A00000X Physician Assistant (Licence: PA MA062515) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2024-11-12 |