| NPI | 1265535629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ME PA595) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: ME PA595) |
| 363A00000X Physician Assistant (Licence: ME PA595) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2011-07-26 |