| NPI | 1720622764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009696) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 028236) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-11-02 |
| Last Update Date | 2024-01-19 |