| NPI | 1245409135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0003400) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2024-07-09 |