| NPI | 1922721026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 12163) |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2024-03-08 |