| NPI | 1477515625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 001459) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9102379) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2007-11-20 |