| NPI | 1972323608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2024037300) |
| Enumeration Date | 2024-10-16 |
| Last Update Date | 2025-07-10 |