| NPI | 1508825605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3443-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA850) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2025-03-03 |