NPI | 1750362539 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 000970) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2005-11-09 |
Last Update Date | 2007-12-06 |