| NPI | 1780332304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 16851-I) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 236-P.A.) |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2024-01-04 |