| NPI | 1205334943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: IL 238000565) |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 238000565) | |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2023-04-14 |