| NPI | 1427831767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA2548) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME PA2548) |
| Enumeration Date | 2023-08-18 |
| Last Update Date | 2024-01-15 |