| NPI | 1720217789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: RI PA00715) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00715) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2019-11-26 |