| NPI | 1831236520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA19843) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT CT 001443) |
| 363A00000X Physician Assistant (Licence: NY 009824) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2013-08-09 |