| NPI | 1083384036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: RI APRN02825) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: RI RN1047330) |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2021-12-15 |