| NPI | 1225591886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11023363A) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX SA00792) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2024-06-25 |