| NPI | 1053909895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA01584) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: RI PA01584) |
| 363A00000X Physician Assistant (Licence: NE 1167869) | |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2024-07-12 |