| NPI | 1437591971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 23.003095) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056252) |
| 363A00000X Physician Assistant (Licence: VA 0110004314) | |
| 363A00000X Physician Assistant (Licence: CT 23.003095) | |
| 363AM0700X Physician Assistant, Medical (Licence: CT 23.003095) | |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2021-06-29 |