| NPI | 1396217287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA14242) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 12955) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2022-01-13 |