| NPI | 1477584613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ME PA-535) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NH 0567) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2012-03-13 |