| NPI | 1124440672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: ME PA1897) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA1897) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2024-03-26 |