| NPI | 1285173021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA00941) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2024-01-31 |