| NPI | 1376127704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA423) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: ME 23182) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2023-11-17 |