| NPI | 1831342666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: RI PA00544) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA AP2570) |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2017-01-04 |