NPI | 1174740518 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055-0030833) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011564-1) |
363A00000X Physician Assistant (Licence: MA 1265) | |
Enumeration Date | 2007-04-19 |
Last Update Date | 2023-03-07 |