| NPI | 1720155385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA1593) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 0697) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2017-05-24 |