NPI | 1962057836 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9243) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA194962) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-08-07 |
Last Update Date | 2024-02-13 |