| NPI | 1235618497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA01074) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: RI PA01074) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2024-07-12 |