| NPI | 1609810555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 0500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 00324) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2011-10-31 |