NPI | 1649457730 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055-0031080) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 0664) |
363A00000X Physician Assistant (Licence: MA AP 2506) | |
363A00000X Physician Assistant (Licence: VT 055-0031081) | |
Enumeration Date | 2008-01-30 |
Last Update Date | 2011-01-19 |