| NPI | 1043251325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06453) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA-586) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2024-05-06 |