| NPI | 1215305222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ME PA2204) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA5526) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2022-07-18 |