| NPI | 1881629657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NH 0315p) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ME PA-619) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2019-03-11 |