| NPI | 1124453386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: RI APRN03067) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: RI RN52152) |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2022-05-19 |