| NPI | 1467064220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7737) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA2508) |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2024-04-25 |