| 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 |