| NPI | 1750324034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 5777) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9104367) |
| 363A00000X Physician Assistant (Licence: NY 010303) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2022-10-11 |