| NPI | 1437253655 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 4265) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: RI PA00249) |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2019-05-08 |