NPI | 1679279012 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL PA9117576) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2023-02-07 |
Last Update Date | 2024-02-05 |