NPI | 1316576044 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA15352) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 4585) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-04-04 |
Last Update Date | 2022-03-02 |