| NPI | 1528471687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 3330) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 3330) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00336900) | |
| 363A00000X Physician Assistant (Licence: NY 23 017623) | |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2021-02-23 |