| NPI | 1982842100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1795) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00675) |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2022-01-10 |