| NPI | 1417447277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6535) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 1977) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2024-12-04 |