| NPI | 1194263905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: RI APRN01552) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: RI APRN01552) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2026-04-22 |