| NPI | 1437224763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA00519) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 001516) |
| 363A00000X Physician Assistant (Licence: MA 2271) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2010-02-09 |