| NPI | 1427806116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 6177) |
| Enumeration Date | 2024-05-08 |
| Last Update Date | 2026-02-11 |