| NPI | 1801043914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 6015) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 013719) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2023-03-23 |