| NPI | 1265016042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA01342) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA102938) |
| Enumeration Date | 2021-05-08 |
| Last Update Date | 2026-09-04 |