| NPI | 1144607201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1138) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA5368) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2016-01-04 |