| NPI | 1962466326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CT 786) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 000786) |
| 363A00000X Physician Assistant (Licence: CT 786) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2022-02-21 |