| NPI | 1356097141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9117099) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA2326) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2022-03-01 |
| Last Update Date | 2025-03-11 |