| NPI | 1487987475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-10150) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110004452) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2024-03-19 |