| NPI | 1346903440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351049413) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-10-16 |
| Last Update Date | 2022-06-13 |