| NPI | 1750348116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ME PA315) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9103682) |
| 363A00000X Physician Assistant (Licence: ME PA001241) | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2023-03-07 |