| 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 |