| NPI | 1376245936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC377) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY TC377) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2023-06-06 |