NPI | 1619379872 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 3198) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2014-09-18 |
Last Update Date | 2020-10-27 |