| NPI | 1033327705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA 2589) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 3089) |
| 363A00000X Physician Assistant (Licence: NH 0643) | |
| 363A00000X Physician Assistant (Licence: NH 003089) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2011-11-16 |