| NPI | 1275161689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1862) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NH PA1862) |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2024-11-20 |