NPI | 1164814109 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 123246) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
363AS0400X Physician Assistant, Surgical | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2015-02-27 |
Last Update Date | 2023-05-18 |