| NPI | 1144209438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 001483) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 0122851) |
| 363A00000X Physician Assistant (Licence: MA AP1797) | |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2020-11-06 |