| NPI | 1205207875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE JOAN LACOSTE Physician Assistant 508-344-7504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 019025-1) |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2015-10-08 |