An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
| Specialty | Taxonomy Code | |
|---|---|---|
| * | Student in an Organized Health Care Education/Training Program | 390200000X |
| Emergency Medicine | 207P00000X | |
| Physician Assistant | 363A00000X |
* Indicates primary specialty
| NPI Number | 1255030078 |
| Credentials | PA-C (Physician Assistant-Certified) |
| Entity | Individual |
| Enumeration date | 03/01/2023 |
| Last updated | 08/13/2025 - About 10 months ago |
| Sole proprietor1 | No |
| Identifiers |
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| Hospital affiliation | n/a |
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.
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