| NPI | 1295249274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2021045980) |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2021-12-15 |