| 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 |