| NPI | 1104834837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA333) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA237) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2014-02-21 |