| NPI | 1477909448 |
|---|---|
| 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: IL 238.000495) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2024-06-13 |