NPI | 1720466972 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055-0031277) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 1098) |
Enumeration Date | 2015-05-08 |
Last Update Date | 2015-12-30 |