NPI | 1629266077 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ME PA223) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA223) |
363AM0700X Physician Assistant, Medical (Licence: ME 001105) | |
Enumeration Date | 2007-10-11 |
Last Update Date | 2019-03-11 |