| NPI | 1033138383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 4932) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 19953) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2022-11-02 |