| NPI | 1588151575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA01054) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2018-07-05 |