| NPI | 1134302334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 000200) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00318) |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2007-12-11 |