| NPI | 1225125834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ME PA697) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 000792) |
| 207P00000X Emergency Medicine (Licence: NY 000792) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2013-03-06 |