| NPI | 1427431212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 004365) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C05853) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2022-09-29 |