| NPI | 1336789767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AK 203147) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2020-01-14 |
| Last Update Date | 2025-01-21 |