| NPI | 1225755937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ME PA2529) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 5931) |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2023-09-08 |