NPI | 1477151769 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13649) |
Additional Taxonomies | 363A00000X Physician Assistant |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-10-09 |
Last Update Date | 2024-08-14 |