| NPI | 1366879637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: RI APRN02737) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2288980) |
| 163W00000X Registered Nurse (Licence: RI RN52124) | |
| 363L00000X Nurse Practitioner (Licence: MA RN2288980) | |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2024-10-10 |