| NPI | 1508305707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA65384) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA2028) |
| 363A00000X Physician Assistant (Licence: MA PA6046) | |
| 363AS0400X Physician Assistant, Surgical (Licence: ME PA2028) | |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2026-01-09 |