| NPI | 1801332507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA01375) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: RI LDN00892) |
| Enumeration Date | 2017-01-18 |
| Last Update Date | 2022-09-09 |