| NPI | 1326796277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: RI APRN03026) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN-TEMP14701) |
| 363L00000X Nurse Practitioner (Licence: MA RN2338572) | |
| Enumeration Date | 2022-03-10 |
| Last Update Date | 2024-06-03 |