| NPI | 1942483490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 002045) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: CT 002045) |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2010-08-27 |