| 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 |