| NPI | 1225402746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 57577) |
| Additional Taxonomies | 246ZX2200X Specialist/Technologist, Other Orthopedic Assistant (Licence: CA 12-0812) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-11-20 |
| Last Update Date | 2019-12-09 |