| NPI | 1033494810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1573) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA001299) |
| Enumeration Date | 2011-10-12 |
| Last Update Date | 2020-02-26 |