| NPI | 1437473998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI APRN02195) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G105783) |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2026-05-20 |