NPI | 1760823900 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008975) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VT 055-0031643) |
363A00000X Physician Assistant (Licence: WY PA662) | |
363A00000X Physician Assistant (Licence: WA PA60485019) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2013-07-16 |
Last Update Date | 2023-03-02 |