| NPI | 1447547864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: ME PA001275) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA1275) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2019-04-01 |