| NPI | 1528003407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 000443) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 675) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2007-10-16 |