| NPI | 1801233663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD-622) |
| 363A00000X Physician Assistant (Licence: MI 5601006686) | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2024-03-21 |