| NPI | 1912927971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: ME PA575) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: ME PA575) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2023-06-30 |