| NPI | 1215029848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 008082) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001093) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2018-03-17 |