| NPI | 1740556661 |
|---|---|
| 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: NY 278430) |
| 207R00000X Internal Medicine (Licence: NY 278430) | |
| Enumeration Date | 2012-03-25 |
| Last Update Date | 2023-07-07 |