| NPI | 1316984412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NH 0157P) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA-878) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2017-02-27 |