NPI | 1508305707 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA2028) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6046) |
363AS0400X Physician Assistant, Surgical (Licence: ME PA2028) | |
Enumeration Date | 2017-02-21 |
Last Update Date | 2020-04-23 |