| NPI | 1497741979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NH 0469) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VT 055-0030569) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2018-10-03 |