| NPI | 1942784160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: 57499) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 57499) |
| 363A00000X Physician Assistant | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2020-04-01 |