| NPI | 1467429910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA00225) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA1130) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2022-12-21 |