| NPI | 1023140035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ME PA2184) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO PA0003781) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2025-01-07 |