| NPI | 1730418757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 02363) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 2363) |
| 111N00000X Chiropractor (Licence: CT 1828) | |
| Enumeration Date | 2009-12-22 |
| Last Update Date | 2013-04-26 |