| NPI | 1932351673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 002060) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 002060) | |
| Enumeration Date | 2008-10-14 |
| Last Update Date | 2025-05-13 |