| NPI | 1154510170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1121) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VT 055-0030972) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2024-09-11 |