| NPI | 1437480423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 19507) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: RI NPP37581) |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2016-01-11 |