| NPI | 1760375463 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2025-05-31 |
| Last Update Date | 2026-04-07 |