| NPI | 1912434036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1321) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VT 0550031341) |
| Enumeration Date | 2017-05-19 |
| Last Update Date | 2019-01-16 |