| NPI | 1861805640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 363AM0700X Physician Assistant, Medical (Licence: PR 003-P.A.) | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2025-04-24 |