| NPI | 1093726366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 0550030562) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 0416P) |
| 363AS0400X Physician Assistant, Surgical (Licence: VT 0550030562) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NH 0416P) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2008-02-28 |