NPI | 1710356274 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA00905) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 746014) |
Enumeration Date | 2015-09-15 |
Last Update Date | 2016-12-19 |