| NPI | 1902208887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS023814) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 017995-1) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2024-06-25 |