NPI | 1386241727 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001014542) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA8512) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-10-08 |
Last Update Date | 2024-09-16 |