| NPI | 1619918919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9110525) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: ME PA-654) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2018-07-05 |