| NPI | 1952539132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: RI PA01322) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6129) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2021-09-02 |