| NPI | 1780250373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ME PA2963) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA8181) |
| 363A00000X Physician Assistant (Licence: ME PA2963) | |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2025-10-29 |