| NPI | 1407893506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 0164P) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA-879) |
| 363A00000X Physician Assistant (Licence: MA PA2084) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2017-02-27 |