| NPI | 1245827351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9114096) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: FL 9114096) | |
| 363A00000X Physician Assistant (Licence: TX PA14600) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-12-22 |
| Last Update Date | 2023-05-19 |