| NPI | 1023721362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA01673) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA101634) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2023-01-02 |
| Last Update Date | 2025-06-20 |