Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2018-02-21
- Last updated
- 2018-02-21
Specialties
Licenses
- License NH
- PhT07288
Location
- Practice location
- 82 MAMMOTH RD
- City
- HOOKSETT NH
- Postal code
- 031061155
- Phone
- 603-913-5764
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.