| NPI | 1063100873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA01574) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI PA01574) |
| Enumeration Date | 2023-04-28 |
| Last Update Date | 2023-05-19 |