| NPI | 1518148873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ME PA1385) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 1939) |
| 363A00000X Physician Assistant (Licence: FL PA9104343) | |
| 363AS0400X Physician Assistant, Surgical (Licence: AL PA644) | |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9104343) | |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2022-07-22 |