| NPI | 1831736396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA7944) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA PA7944) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-12-04 |
| Last Update Date | 2023-04-12 |