| NPI | 1770273385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 12891) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-05-09 |
| Last Update Date | 2025-05-06 |