NPI | 1679040794 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL PA9117633) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-10-26 |
Last Update Date | 2024-08-30 |