NPI | 1639785470 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MO 2020026547) |
Enumeration Date | 2020-09-17 |
Last Update Date | 2023-03-21 |