| NPI | 1417767658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225500000X Specialist/Technologist |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2025-01-09 |
| Last Update Date | 2025-01-09 |