| NPI | 1962598516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: RI PA00002) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MT 289) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2018-09-18 |