| NPI | 1417342742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1967) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 29645) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2023-02-20 |