| NPI | 1316378938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: RI ETL02458) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95000019) |
| Enumeration Date | 2013-12-07 |
| Last Update Date | 2020-09-23 |