NPI | 1821689597 |
---|---|
Other Name | TREY WINDHAM |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 4260) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2021-01-26 |
Last Update Date | 2023-11-22 |