| NPI | 1023323359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA1233) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA001233) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2023-09-28 |