NPI | 1174700934 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2008-01-23 |
Last Update Date | 2020-06-11 |