| NPI | 1922262542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1301) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: ID PTA2406) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-13 |
| Last Update Date | 2016-03-24 |