| NPI | 1558326405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 011395) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 000143) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2018-04-06 |