| NPI | 1487241709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic | |
| Enumeration Date | 2020-12-22 |
| Last Update Date | 2026-06-10 |