| NPI | 1407278906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER GAMACHE Pec Coordinator 508-923-7611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2014-01-17 |
| Last Update Date | 2014-01-17 |