| NPI | 1265550990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA1058) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA 0015058) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2014-12-23 |