| NPI | 1487372314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R79181) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2022027022) |
| Enumeration Date | 2022-08-17 |
| Last Update Date | 2022-08-17 |