| NPI | 1689600298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA2928) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 004258) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2025-09-05 |