| NPI | 1124145784 |
|---|---|
| Former Name | GEORGE L SOUTHWICK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA2512) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 0533) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2013-08-01 |