NPI | 1861707382 |
---|---|
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: FL PA9105280) |
Enumeration Date | 2010-08-09 |
Last Update Date | 2023-07-07 |