| NPI | 1205437498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: RI PA01516) |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2022-12-28 |