| NPI | 1417580754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12005) |
| Additional Taxonomies | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: ME PA2034) |
| Enumeration Date | 2020-02-14 |
| Last Update Date | 2022-02-23 |