| NPI | 1457010977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1814) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1814) |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2021-12-13 |
| Last Update Date | 2023-10-15 |