| NPI | 1205892924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA00053) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 1279) |
| 363AM0700X Physician Assistant, Medical (Licence: MA 1279) | |
| 363AM0700X Physician Assistant, Medical (Licence: RI PA00053) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2008-02-28 |