| NPI | 1982793998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ME PA2173) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-05956) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2021-12-06 |