| NPI | 1689306953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA64420) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0007736) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2024-11-27 |