| NPI | 1740461060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ME PA001205) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2010-06-22 |