| NPI | 1548528870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055.0031128) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 089.0001082) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2013-09-26 |