| NPI | 1497804397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: RI PA00432) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA PA1585) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2024-06-06 |