| NPI | 1417349382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1180) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA1509) |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2024-02-02 |