| NPI | 1912098591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 3590) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA AP2108) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2026-01-30 |