| NPI | 1205318409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA2218) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA PA6649) |
| 207P00000X Emergency Medicine (Licence: ME PA2218) | |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2024-10-01 |