| NPI | 1205376357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: RI APRN01652) |
| Additional Taxonomies | 163WI0600X Registered Nurse, Infection Control (Licence: RI RN49347) |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2017-10-11 |