| NPI | 1750823282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA00925) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 6871) |
| 363A00000X Physician Assistant (Licence: NH 3572) | |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2026-03-17 |