| NPI | 1801032354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: RI PA00470) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2009-01-05 |
| Last Update Date | 2011-09-09 |