| NPI | 1467524074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA PA5605) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2024-04-12 |