| NPI | 1275731861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: RI APRN00959) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 153306) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2021-04-22 |