| NPI | 1316902489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA3777) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00486) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 013021) | |
| 174400000X Specialist (Licence: RI AT00163) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2024-04-23 |