| NPI | 1831408632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 2472) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05676) |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2024-03-22 |