| NPI | 1396102299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10087533) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA10391) |
| Enumeration Date | 2016-01-22 |
| Last Update Date | 2024-04-03 |