NPI | 1356097141 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA2326) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical |
Enumeration Date | 2022-03-01 |
Last Update Date | 2023-02-09 |