| NPI | 1245465038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA-249) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME PA249) |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2019-04-01 |