| NPI | 1356308373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ME PA-795) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 004272-1) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2011-04-08 |