| NPI | 1275235566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 7916) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 7916) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2025-05-16 |