| NPI | 1760275630 |
|---|---|
| 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 |
| Enumeration Date | 2025-05-23 |
| Last Update Date | 2025-05-23 |