| NPI | 1518229145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ME PA1342) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-06680) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2022-01-04 |