NPI | 1952365322 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA00644) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI CPA00644) |
Enumeration Date | 2006-04-13 |
Last Update Date | 2025-01-09 |