| NPI | 1447652490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 23.003178) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 017947) |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2016-09-01 |