| NPI | 1700969151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NH 1701) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA OA002746) |
| Enumeration Date | 2006-10-21 |
| Last Update Date | 2021-04-02 |