| NPI | 1639485758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA21098) |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA21098) | |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2022-05-12 |