| NPI | 1932824711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055.0031704) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME PA2433) |
| 363A00000X Physician Assistant (Licence: ME PA2433) | |
| Enumeration Date | 2022-10-05 |
| Last Update Date | 2023-10-24 |