NPI | 1851046403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 5598) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC284) |
363AM0700X Physician Assistant, Medical (Licence: KY TC284) | |
363AS0400X Physician Assistant, Surgical (Licence: KY TC284) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2022-02-12 |
Last Update Date | 2023-08-16 |