| NPI | 1356991657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 61606) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA13917) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2023-05-12 |