NPI | 1619429404 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
363AS0400X Physician Assistant, Surgical (Licence: TX SA000718) | |
Enumeration Date | 2016-10-27 |
Last Update Date | 2022-04-01 |