| NPI | 1235789231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: RI APRN02399) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2313022) |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2023-01-05 |