| NPI | 1073522215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA-854) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 3748) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2009-07-31 |