| NPI | 1336541804 |
|---|---|
| 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: WA OA60635098) |
| 363AM0700X Physician Assistant, Medical (Licence: WA OA60635098) | |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2017-04-18 |