| NPI | 1902025281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 001670) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 007930) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2008-02-28 |