NPI | 1235788753 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: HI MD-12851) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-09-06 |
Last Update Date | 2022-04-13 |