| NPI | 1801340195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA00906) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6584) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2024-06-06 |