NPI | 1346619566 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA057853) |
Enumeration Date | 2015-09-17 |
Last Update Date | 2025-01-26 |