| NPI | 1932647112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TN 5089) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA1675) |
| 363A00000X Physician Assistant (Licence: TN 5089) | |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2024-02-27 |