| NPI | 1922627710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA01303) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA7994) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-11 |
| Last Update Date | 2021-03-16 |