| NPI | 1992287932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 4330) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: CT 4330) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2018-11-12 |