| NPI | 1396707873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ME PA2288) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WI 1338-023) |
| 363AS0400X Physician Assistant, Surgical (Licence: MI 5601006358) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2022-04-04 |