| NPI | 1164901492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1905) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2023-11-17 |