NPI | 1902591381 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2023-04-10 |
Last Update Date | 2024-07-31 |