| NPI | 1912918731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA01655) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 102412) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2024-03-20 |