| NPI | 1831476506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 006327) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA 53067) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-11-09 |
| Last Update Date | 2023-12-11 |