| NPI | 1427541564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055.0031745) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 021978) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2024-02-08 |