| NPI | 1205291754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 023483) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-12-29 |
| Last Update Date | 2023-12-08 |