| NPI | 1699207621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1509) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PAN1685) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2019-08-19 |