| NPI | 1225656085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113642) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9113642) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2020-11-11 |