NPI | 1528501582 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA58454) |
Additional Taxonomies | 363A00000X Physician Assistant |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-11-23 |
Last Update Date | 2022-12-07 |