NPI | 1558678433 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 2474) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 015493) |
363AM0700X Physician Assistant, Medical (Licence: MA PA8052) | |
Enumeration Date | 2010-09-13 |
Last Update Date | 2025-04-09 |