| NPI | 1346892114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: RI APRN02100) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2297383) |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2024-04-18 |