NPI | 1457847790 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA01444) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2018-07-10 |
Last Update Date | 2023-10-02 |