| NPI | 1811612658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: NY 029192-01) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-10-04 |
| Last Update Date | 2023-02-02 |