| NPI | 1194599514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: RI APRN04111) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2325629) |
| Enumeration Date | 2023-11-07 |
| Last Update Date | 2026-02-04 |