| NPI | 1215631742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 63188) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2024-02-15 |