| NPI | 1629168901 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL T. POSHKUS Medical Program Director 401-462-1115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: RI PA00221) |
| Enumeration Date | 2006-10-15 |
| Last Update Date | 2022-07-21 |