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 |