| NPI | 1598900649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055.0031113) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013051) |
| 363A00000X Physician Assistant (Licence: NH 0759) | |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2014-02-13 |