| NPI | 1487320974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 23.005372) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 23.005372) |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2023-08-09 |