NPI | 1215277454 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2013-02-26 |
Last Update Date | 2021-03-23 |