| NPI | 1528624012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 315304) |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2023-07-17 |