| NPI | 1497751812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ME PA252A) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ME PA 698) |
| 363AS0400X Physician Assistant, Surgical (Licence: ME PA-698) | |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2011-07-07 |