| NPI | 1932728094 |
|---|---|
| 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 026137) |
| 363A00000X Physician Assistant (Licence: CT 5254) | |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2021-08-16 |