| NPI | 1437566338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 005617) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: ID PA-1993) | |
| Enumeration Date | 2014-07-13 |
| Last Update Date | 2023-03-13 |