| NPI | 1164880142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA2329) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.005771) |
| Enumeration Date | 2016-02-04 |
| Last Update Date | 2024-12-12 |