Individual
KENYON CASTLE BOLTON IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
042.0015361
VT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2018
Last updated
07/21/2021
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