| NPI | 1609304062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ME PA2367) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2022-08-31 |