| NPI | 1841423209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA00564) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA3840) |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2011-08-30 |