| NPI | 1891917381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 002113) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: CT 002113) |
| 363A00000X Physician Assistant (Licence: CT 002113) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2015-04-03 |