| NPI | 1790310985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ME PA2036) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA2036) |
| Enumeration Date | 2020-03-08 |
| Last Update Date | 2025-03-27 |