NPI | 1588394373 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
Additional Taxonomies | 363A00000X Physician Assistant |
363AS0400X Physician Assistant, Surgical | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2022-06-14 |
Last Update Date | 2024-01-27 |