| NPI | 1922309806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 23.2727) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 014383) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 014383) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 23.2727) | |
| Enumeration Date | 2010-11-09 |
| Last Update Date | 2018-03-01 |