| NPI | 1609891670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 780) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001223) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2023-03-07 |