| NPI | 1326328303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN 2177) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA1992) |
| 363A00000X Physician Assistant | |
| 363A00000X Physician Assistant (Licence: TN 2177) | |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2021-02-01 |