NPI | 1376626440 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: RI PA00067) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: RI PA00067) |
Enumeration Date | 2006-10-23 |
Last Update Date | 2021-08-19 |