| NPI | 1245388891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110004884) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA-138) |
| 363AM0700X Physician Assistant, Medical (Licence: ME PAN686) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2018-01-11 |