| NPI | 1730567280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA171679) |
| 207P00000X Emergency Medicine (Licence: FL OS20504) | |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2023-12-27 |