| NPI | 1144294117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ME PA1896) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 0580) |
| 363A00000X Physician Assistant (Licence: ME PA1896) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2019-03-01 |