| NPI | 1194076521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: RI APRN00346) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 21866) |
| 363L00000X Nurse Practitioner (Licence: RI NPP37837) | |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2016-08-17 |