| NPI | 1376273243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA2395) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME Pending) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2022-08-02 |