| NPI | 1467682377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 000788) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 006951) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2012-03-29 |