NPI | 1407235500 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 06532) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD A00504) | |
363AM0700X Physician Assistant, Medical (Licence: MA PA7751) | |
Enumeration Date | 2015-05-21 |
Last Update Date | 2024-09-26 |